Routine Medicine Laboratory Testing _ CÁC XÉT NGHIỆM THƯỜNG QUY ÁP DỤNG TRON...
Aeha -aha symposium-nov-2005-short
1. AHA- Nov 12, 2005 , Dallas
P.K.Shah, MD
Director of Cardiology and Atherosclerosis Research Center,
Cedars-Sinai Medical Center,
Professor of Medicine,
David Geffen School of Medicine at UCLA
Los Angeles, California
Imperative to Detect Subclinical Atherosclerosis
3. Coronary Artery Disease
4 out of every 10 individuals who develop
a heart attack or sudden death from
coronary artery disease
have no prior warning or symptoms
4. CVD Risk Assessment in Asymptomatic Normal Subjects
Limitations of the Traditional Approach
PKS- CSMC
*One or more “Risk Factor” Accounts for 80-90% of
CHD Events
*Therefore Risk Factors can Predict most CHD Events
5. CVD Risk Assessment in Asymptomatic Normal Subjects
Limitations of the Traditional Approach
PKS- CSMC
0
10
20
30
40
50
60
70
80
90
100
Death Death/MI
% with > 1 Risk Factors
No Death/MINo Death
men
women
6. Pathophysiologic Paradigm in AtherosclerosisPathophysiologic Paradigm in Atherosclerosis
Oxidant StressOxidant Stress
Inflammatory Gene ActivationInflammatory Gene Activation
AtherosclerosisAtherosclerosis
Inflammatory Cell Recruitment/ActivationInflammatory Cell Recruitment/Activation
Modified LDL
Other mechanisms
Other mechanisms
Othermechanisms
Other mechanisms
Plaque-disruption/ThrombosisPlaque-disruption/Thrombosis
Genes Genes
Price M and Shah PK: Harrison’s Textbook of Medicne Online 2002
LDL , HDL , Diabetes-IRS-Metabolic Synd , Hypertension , Genetics, Others
7. Lipoproteins
Entry into Subendothelial Space
Lipoprotein Binding and Retention
Lipoprotein Modification (oxidation)
Inflammatory Gene Induction
Inflammation
Immune Activation
Athero-prone sites
8. LDL with Reduced Binding Affinity to Subendothelial Matrix is Associated
With Reduced Atherosclerosis Despite Severe Hypercholesterolemia
Skalen K et al: Nature 417:750:2002
Defective LDL
Normal LDL
12. CVD Risk Assessment: A Different Paradigm
Traditional Risk Factor Based Disease Modification
Imaging for Identification of Subclinical Atherosclerosis
EBCT-MSCT, Carotid IMT, MRI
Non-invasive Assessment of Vascular Function
BART, ABI, Compliance , Stress Test
Markers for Disease Activity
Inflammatory and other Biomarkers
PKS- CSMC